Provider Demographics
NPI:1639688427
Name:COLLEEN T PECK MD PLLC
Entity Type:Organization
Organization Name:COLLEEN T PECK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-301-9856
Mailing Address - Street 1:36116 SE 89TH PL
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9789
Mailing Address - Country:US
Mailing Address - Phone:425-301-9856
Mailing Address - Fax:
Practice Address - Street 1:36116 SE 89TH PL
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9789
Practice Address - Country:US
Practice Address - Phone:425-301-9856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000201322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty